Open Letter to President Obama For Presidential Pardon of
Bernie Ellis' Felonization for Medical Cannabis Distribution
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2/27/2011
President Barack Obama
1600 Pennsylvania Avenue NW Washington, DC 20500
Sunil Aggarwal, MD, PhD
Dear President Obama:
I am writing on behalf of Bernard H. Ellis, Jr., MA, MPH[1], federal Bureau of Prisons number 16502-075, who is petitioning you for a felony pardon. I am aware that Mr. Ellis pled guilty to a single charge of manufacturing 100 or more cannabis plants in 2003, that he was sentenced to four years probation (later reduced to two years) without any fine in his criminal case, although he was incarcerated at a federal Bureau of Prisons halfway house for eighteen months of that time. I am further aware that the federal government continued to pursue a civil asset forfeiture action against Mr. Ellis to confiscate his farm, necessitating that Mr. Ellis surrender 25 acres of his Tennessee farm in order to keep the rest. I am aware that Mr. Ellis was not accused of selling marijuana and freely admitted using it and giving it to terminally ill neighbors. I am aware that the total financial loss suffered by Mr. Ellis, despite his cooperation, now exceeds $1 million in foregone income, legal expenses, and the value of the land he surrendered. Finally, I am aware that the total amount of usable cannabis found on Mr. Ellis’ farm, according to government estimates, was between seven and eight pounds.
I would like to introduce myself on both personal and professional levels in an effort to better relate with you. Personally, as a South Asian American who was raised in a predominantly rural Oklahoma county, I empathize with your biracial identity as I consider myself a bicultural American. I was brought nearly to tears when I heard your video recorded Diwali greeting of “Saal Mubarak” a few years ago from the White House. Thank you very much for that sentiment. Muskogee, Oklahoma, where I grew up, had desegregated its schools only nine years before the time of my birth there, so the sting of normalized racism and cultural chauvinism was part of my upbringing there. Now I live in Seattle, Washington, and I understand that your mother moved from Oklahoma (Ponca City, a school we used to “compete” with) to Seattle when she was in elementary school. Interestingly, as you have a mother who got her PhD in Anthropology, I married a woman 2 years ago who also has her PhD in Anthropology. I made my way to Seattle via UC Berkeley, which is where I learned the “facts” about cannabis and had other life-changing experiences, as one is apt to do in college. Professionally, I am a physician-scientist and medical geographer currently in the first year of my residency. During medical school, I was a delegate to the AMA Medical Student Section, and I successfully lobbied the AMA, through education and internal coalition-building, to change their position on the scheduling status of cannabis, or ‘mari(h/j)uana’ as it is known in the federal schedules. The AMA now urges the government to reconsider the schedule I status of this substance and have struck down their prior policy advocating for its retention in schedule I. This development was broadcast on CNN (http://www.youtube.com/watch?v=zocYnuEuaSA), the LA Times, Nature, Scientific American, CBSNews, Newsweek, and many other outlets. My contributions to the effort were cited in these articles as well. See http://blog.seattlepi.com/thebigblog/archives/184808.asp for the local story. With the previous strongly-worded statement of support from the American College of Physicians, now the two largest and oldest groups of physicians in the United States, each with over 100,000 members, are calling on you to reschedule marijuana.
For my doctoral research, I was awarded an NSF graduate research fellowship, and I conducted the first human subject studies with medical cannabis-using patients who were protected with NIH-issued federal certificates of confidentiality. It was the first research in the United States on medical marijuana patients that looked at both sites of medical access (medical records review) and delivery. I have authored several publications based on this research and related work in peer-reviewed journals, and I recently published an article in the Denver University Law Review, which you may find useful.
My goal is to spur you to change the classification of cannabis at the federal level. I have started a group, Health Professionals for Responsible Drug Scheduling (109 fans on Facebook page and 11 physicians and medical students, several nurses, pharmacy students, and researchers in our core group). I wrote a letter to the Senate Judiciary Committee to oppose your nomination of Michele Leonhart as DEA Chief Administrator. You can find the letter here.
Where do you stand on this issue? Allow me to quote your words:
My attitude is, if the science and the doctors suggest that the best palliative care and the best way to relieve pain and suffering is through medical marijuana then that’s something I’m open to, because there’s no difference between that and morphine when it comes to just giving people relief from pain. But I want to do it under strict guidelines. I want to make sure that it is prescribed in the same way that other painkillers or palliative drugs would be prescribed. I’m concerned about folks just kind of growing their own and saying it’s for medicinal purposes, because that’s kind of a slippery slope.
Nov. 24, 2007, Town Hall meeting Audubon, Iowa
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When it comes to medical marijuana, I have more of a practical view than anything else. My attitude is that if it’s an issue of doctors prescribing medical marijuana as a treatment for glaucoma or as a cancer treatment, I think that should be appropriate because there really is no difference between that and a doctor prescribing morphine or anything else. I think there are legitimate concerns in not wanting to allow people to grow their own or start setting up mom and pop shops because at that point it becomes fairly difficult to regulate.
I’m not familiar with all the details of the initiative that was passed (Oregon Medical Marijuana Act) and what safeguards there were in place, but I think the basic concept that using medical marijuana in the same way, with the same controls as other drugs prescribed by doctors, I think that’s entirely appropriate. I would not punish doctors if it’s prescribed in a way that is appropriate. That may require some changes in federal law. I will tell you that…the likelihood of that being real high on my list is not likely. What I’m not going to be doing is using Justice Department resources to try to circumvent state laws on this issue simply because I want folks to be investigating violent crimes and potential terrorism. We’ve got a lot of things for our law enforcement officers to deal with.
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March 23, 2008 Medford Mail Tribune
The way I want to approach the issue of medical marijuana is to base it on science, and if there is sound science that supports the use of medical marijuana and if it is controlled and prescribed in a way that other medicine is prescribed, then it’s something that I think we should consider.
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So, really, Mr. Obama, the issue here, with regards to Mr. Ellis’s petition, is as you used to say, “the fierce urgency of now” coupled with the aphorism “justice delayed is justice denied[2].” If you are ready to treat medical marijuana like morphine (and your Attorney General, Eric Holder, has recently publically acknowledged that medical marijuana can be a legitimate therapeutic option for chronic illnesses[3]), then you understand that the only thing standing in the way of this is the change in federal law that you and Mr. Holder are empowered by Congress to make. Delay in making the decision, as I write in a paper under review for a pain medicine journal, forces cannabis and many natural cannabinoids to continue to be listed as marijuana in the Schedule I classification, thus 1) hamstringing research, with only a very limited number of clinical trials being approved by federal agencies, 2) impeding development of a pharmacy stocking system needed for inpatient and outpatient empiric treatment trials, and 3) standing at odds with the evidence base and studied recommendations of many major medical associations and expert bodies such as the Institute of Medicine (IOM), the American Medical Association (AMA), and the American College of Physicians (ACP), among others.
This delay is why men and women like Mr. Ellis and others have chosen to take risks to help friends and acquaintances who they know could greatly benefit from this medicinal herb acquire it. What other option do they have? To understand the science and yet to not act on it, knowing that it could improve someone’s health and quality of life, is the real crime, if I may be so bold. Tennessee, you may know, was part of the first wave of medical marijuana laws back in the 1970-1980s where the state’s Department of Health dispensed federally grown cannabis to cancer patients to help with their nausea and vomiting during chemotherapy; the data from TN’s study (and from all the states participating in those programs) showed safety and efficacy[4], but nothing ever came of this as far as policy change at the federal level; instead, laws became more draconian under the Reagan Administration. Interestingly, Al Gore’s sister was a patient who received cannabis under the TN program. If there had been no program, and Bernie had supplied her, would former Vice President and Popular-Presidential-Vote-Getter Gore be ready to felonize him for that, knowing what benefits she would have received from the therapy[5]? I met Mr. Ellis last year at a national conference on cannabis therapeutics after having corresponded with him for over a year on email, as he reached out to me when he heard about my work with the AMA. I can tell you that he is a good and decent human being with an impressive array of accomplishments in the field of public health. Why not make his case the ‘index’ pardon case in which you reverse the ongoing folly of the classification of an herb with demonstrable, reproducible, and scientifically understood medical benefits as one that lacks such traits?
Science and medicine would be on your side in taking such a decision. Did you know that there have been on average two scientific papers EVERY DAY being published on cannabinoid medicines and the endocannabiniod system for the past twenty years, as my colleague Dr. Dustin Sulak of Maine has recently calculated? Cannabis is a thirty-seven million year old plant which interacts with a fundamental signaling system that is over 600 million years old in biology—which we have only recently discovered thanks to the study of cannabis. Incorporating cannabis and cannabis-based medicines in health care would be a significant advancement for this country. Imagine a system that is able to regulate mood, pain, appetite, memory, neuroprotection, muscle relaxation, bone growth, tumor regulation, and other vital functions. We all have such as system, called the endocannabinoid signaling system. The agent that produces molecules in the greatest abundance and variety to intelligently target this system is stuck behind the schedule I firewall. This devaluation is in disservice of humanity. As the Economist magazine once wrote, a publication that understands what is of value, “IF CANNABIS were unknown, and bioprospectors were suddenly to find it in some remote mountain crevice, its discovery would no doubt be hailed as a medical breakthrough. Scientists would praise its potential for treating everything from pain to cancer, and marvel at its rich pharmacopoeia—many of whose chemicals mimic vital molecules in the human body[6].” Even our own US Department of Health and Human Services holds a “novel application” patent on the use cannabinoids as antioxidants and neuroprotectants—for example, to reduce injury immediately following a stroke! Do you see how unbelievably outrageous the position (your administration’s position) that the plant has no medical use is, especially when such a patent is held by the same institution (HHS)[7]? Please ask Secretary Sebelius or Assistant Secretary of Health Koh to correct the record.
Now you may have heard all this before, but I want, for a moment, to address you as a fellow human being who has experienced illness and loss of loved ones due to illness. Did you know that the first demonstration of the anti-tumor properties of cannabinoids was made in 1974, published, and then quietly suppressed[8]? Imagine what we would have developed if we had continued that line of research rather than abandoning it in the name of prejudice? As my colleague Robert Melamede, PhD of Colorado has calculated, there are now over 600 peer reviewed articles, mostly from outside the United States, showing that numerous cancer types (lung, breast, prostate, glioma, thyroid, leukemia, lymphoma, basal cell carcinoma, melanoma, etc.) are killed by cannabinoids in tissue culture and animal studies, including one study of intra-tumoral injection of THC into glioblastoma brain tumors in humans (the same cancer that killed the late Sen. Edward Kennedy). In addition, cannabinoids inhibit the biochemical pathways involved in metastasis and cancer drug resistance. Let me give you one personal example: your beloved late mother, Ann Duhnam—who died in Honolulu, Hawaii on November 7th 1995 from uterine cancer that had spread to her ovaries, at the age of 52 years, 11 months, and 9 days old—lived a remarkable life cut short by an aggressive disease. My guess is that she had endometrial cancer, since the vast majority (95%) of uterine cancers are endometrial cancers, malignancies that arise from the lining of the uterus. Over 35,000 women are diagnosed with this annually. After it spreads to the cervix in its second stage, it can spread via the lymphatic system to the ovaries in its third stage, which is my understanding of what your mother had when she saw physicians at Memorial Sloan-Kettering in New York City. What if I were to tell you that we now know that endometrial cancer cells over-express a certain type of cananbinoid receptor (type 2) on their cell membranes compared to non-cancerous endometrial cells? What if I were to tell you that by blocking that over-expression, it has been demonstrated that you can suppress endometrial cancer cells? And what if I told you that such a blocker is found in natural cannabis, growing all throughout the country (and being eradicated with federal money)? All of what I have said has been published in peer-reviewed scientific journals of endocrinology and pharmacology (see appendix for abstracts of the studies).
One more personal note: this time about your father, Barack Obama, Sr. In 2006, I met Ms. Cora Rubin Weiss at the International Physicians for the Prevention of Nuclear War (IPPNW—a 1985 Nobel Peace Prize-Winning organization) World Congress in Helsinki, Finland at a reception held by the Finnish Government. I was attending as an American Student Delegate. In the course of conversation, I discovered that she was the daughter of the famous anthropologist Vera Rubin whose work I had studied, including an impressive compilation Cannabis and Culture and a federally funded medical anthropological study documenting the fallacy of the ‘amotivational syndrome’ and the cultural rootedness of cannabis use in Jamaica, where the US continues to support violent cannabis prohibition and contrabanding. Vera Rubin’s husband was Samuel Rubin, whose foundation gave your father 3 grants to fund his tuition, books and boarding at the University of Hawai’i, thus helping him become a member of the Airlift family.
So you see, seeing cannabis in positive light would be a natural position for you. President Obama, please issue a Presidential Pardon excusing Mr. Ellis from felonization, and at the same time, please, for the sake of human health and development, pardon us from living under a regime that refuses to acknowledge the medical utility of cannabis. I have seen too many patients denied access to at least try a therapy that could very well help them, discriminated against and stigmatized when they do, and too many good people punished in the course of the enforcement of these unjust laws.
I am starting at NYU this summer to continue my residency in Physical Medicine and Rehabilitation. I would like to bring the facts, science, and humanitarian message regarding cannabis and the entire drug war framework to Washington, DC. Don’t hesitate to call on me.
Sincerely, Sunil Kumar Aggarwal, M.D., Ph.D
APPENDIX: Studies suggesting cannabinoids can fight endometrial cancer
Endocrinology. 2010 Mar;151(3):921-8. Epub 2010 Feb 4.
The levels of the endocannabinoid receptor CB2 and its ligand 2-arachidonoylglycerol are elevated in endometrial carcinoma.
Guida M, Ligresti A, De Filippis D, D’Amico A, Petrosino S, Cipriano M, Bifulco G, Simonetti S, Orlando P, Insabato L, Nappi C, Di Spiezio Sardo A, Di Marzo V, Iuvone T.
Department of Gynecology and Obstetrics and Pathophysiology of Human Reproduction, University of Naples Federico II, 80078 Naples, Italy.
Abstract
The endocannabinoid system plays protective roles against the growth and the spreading of several types of carcinomas. Because estrogens regulate this system both in physiological states and cancer, in this paper we evaluated its involvement in endometrial carcinoma, a well-known estrogen-dependent tumor. To test whether the endocannabinoid system is expressed in endometrial cancer, tissue samples were collected both from 18 patients undergoing surgical treatment for endometrial adenocarcinoma and 16 healthy age-matched controls, and treated for Western blot and immunohistochemical analysis. Moreover, tissues were dounce homogenized and submitted to endocannabinoid measurement by liquid chromatography-mass spectrometry. To evaluate the physiological role of the endocannabinoid system, a human endometrial cancer cell-line (AN3CA) was used and transiently transfected with a plasmid containing the cDNA for the endocannabinoid receptor CB(2). Cells were incubated for 48 h with an agonist (JWH133) (10 mum) or antagonist (SR144528) (1 mum) of CB(2) 24 h after transfection, and cell proliferation was measured by the 3-[4,5-dimethyltiazol-2yl]-2,5 diphenyltetrazolium bromide formazan assay. In human endometrial carcinoma biopsies the expression of CB(2) receptor and the levels of its ligand, 2-arachidonoylglycerol increased, whereas monoacylglycerol lipase, an enzyme responsible for 2-arachidonoylglycerol degradation, was down-regulated. Immunohistochemical analysis revealed that CB(2) was overexpressed only in malignant endometrial cells. CB(2)-overexpressing AN3CA cells showed a significant reduction in cell vitality compared with parental AN3CA cells: incubation with the selective CB(2) antagonist SR144128 restored the viability of CB(2)-overexpressing cells to that of untransfected cells. In conclusion, the endocannabinoid system seems to play an important role in human endometrial carcinoma, and modulation of CB(2) activity/expression may account for a tumor-suppressive effect.
Br J Pharmacol. 2007 Mar;150(5):613-23. Epub 2007 Jan 22.
Cannabidiol displays unexpectedly high potency as an antagonist of CB1 and CB2 receptor agonists in vitro.
Thomas A, Baillie GL, Phillips AM, Razdan RK, Ross RA, Pertwee RG.
School of Medical Sciences, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK. a.thomas@ed.ac.uk
Abstract
BACKGROUND AND PURPOSE: A nonpsychoactive constituent of the cannabis plant, cannabidiol has been demonstrated to have low affinity for both cannabinoid CB1 and CB2 receptors. We have shown previously that cannabidiol can enhance electrically evoked contractions of the mouse vas deferens, suggestive of inverse agonism. We have also shown that cannabidiol can antagonize cannabinoid receptor agonists in this tissue with a greater potency than we would expect from its poor affinity for cannabinoid receptors. This study aimed to investigate whether these properties of cannabidiol extend to CB1 receptors expressed in mouse brain and to human CB2 receptors that have been transfected into CHO cells.
EXPERIMENTAL APPROACH: The [35S]GTPS binding assay was used to determine both the efficacy of cannabidiol and the ability of cannabidiol to antagonize cannabinoid receptor agonists (CP55940 and R-(+)-WIN55212) at the mouse CB1 and the human CB2 receptor.
KEY RESULTS: This paper reports firstly that cannabidiol displays inverse agonism at the human CB2 receptor. Secondly, we demonstrate that cannabidiol is a high potency antagonist of cannabinoid receptor agonists in mouse brain and in membranes from CHO cells transfected with human CB2 receptors.
CONCLUSIONS AND IMPLICATIONS: This study has provided the first evidence that cannabidiol can display CB2 receptor inverse agonism, an action that appears to be responsible for its antagonism of CP55940 at the human CB2 receptor. The ability of cannabidiol to behave as a CB2 receptor inverse agonist may contribute to its documented anti-inflammatory properties.
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[1] BA in Psychology, Sociology and Political Science from Vanderbilt University; MA in Sociology (Demography and Human Ecology) from the University of Texas at Austin; MPH (Public Health Education and Epidemiology) from the University of California at Berkeley; additional graduate training in Sociology at Vanderbilt University and in Health Communication, Health Promotion, and Medical Anthropology at Stanford University.
[2] Coined by William Gladstone, a 19th Century British politician, but can be traced to the Magna Carta
[3] http://stopthedrugwar.org/speakeasy/2011/feb/10/holders_latest_comment_about_med
[4] http://www.cannabis-med.org/membersonly/mo.php?aid=2001-01&fid=2001-01-2&mode=p&sid=)
[5] http://www.mpp.org/news/press-releases/thirteen-existing-state-laws-permit-medical-marijuana-distributi.html
[6] http://www.economist.com/node/6849915
[7] http://coloradoindependent.com/47995/feds-theres-no-medical-marijuana-except-our-medical-marijuana
[8] http://norml.org/pdf_files/NORML_Cannabinoids_Cancer_Hope.pdf
